Molecular characterization of autosomal recessive non syndromic hearing loss in selected families from district Mardan, Pakistan

Deafness is the most common sensory disorder, which affects 1/1000 neonates globally. Genetic factors are major contributors for hearing impairment. This study was conducted to explore the linkage of DFNB loci and their mutations with NSHL in selected Pakistani families. We included 10 families with history of deafness from district Mardan, Pakistan. Blood sample [5ml] along with personal and clinical information was collected from the available family members including both diseased and un-affected individuals. Genomic DNA was amplified using loci specific STR markers to investigate the linkage of DFNB loci. Family found linked with DFNB4 locus was screened for SLC26A4 mutations. One out of the ten explored families was found linked with DFNB4 locus which was further investigated for SLC26A4 gene mutation through direct DNA sequencing. Two novel mutations were observed in the studied family, one at splice donor site [164+2T>G] and the other at position 164+5C>G only in the affected members of the linked family. DFNB4 locus was found linked in the present study which harbors SLC26A4 gene. The novel mutation of SLC26A4 gene at the splice donor site results in skipping of the first coding exon and thus can lead to loss of expression of SLC26A4 product in the inner ear

Molecular occurrence of canine babesiosis in rural dog population in Pakistan

@#Canine babesiosis is an important tick-borne protozoal disease of dogs that poses major health problem worldwide. Farm dogs in rural areas are the companion animals, that not only watch the livestock herds but also guard the house of the owners. Each farmer keeps his companion dog to get all the services. In our study, a total of 450 blood samples of farm dogs from three different ecological zones (Southern, Central and Northern regions of the province; Punjab) of Pakistan, were collected to examine through microscopy and PCR. Examination of thin blood smears revealed an overall prevalence of 12.8% (58/450) of canine babesisal parasites. However, PCR analysis revealed 46.8% (211/450) and 7.3% (33/450) samples positive for B. gibsoni and B. vogeli, respectively. The amplicons of 671 bp and 590 bp were amplified for the detection of B. gibsoni and B. vogeli, respectively through PCR. The results of multivariate analysis showed that the occurrence of canine babesiosis is higher in the Central Punjab and younger age of the dogs, while breed and sex of the host were not significantly associated with the occurrence of the disease. Mixed infection of B. gibsoni and B. vogeli was observed only in 3 dogs each in district Kasur and Rawalpindi. Our study is the first report to observe the occurrence of canine babesiosis in rural dogs in Pakistan through PCR.

Comparison of karydakis technique with limberg flap procedure for sacrococcygeal pilonidal sinus disease in terms of hospital stay and work loss

Objective: To compare Karydakis technique with Limberg flap procedure for sacrococcygeal pilonidal sinus in terms of mean period of hospital stay and return to normal activity [mean number of days]

Study Design: Randomized controlled trial

Place and Duration of Study: Surgery department, Military Hospital /Combined Military Hospital Rawalpindi, Frontier Corps [FC] Hospital Quetta from July 2010 to July 2014

Material and Methods: A total of 150 patients [75 patients in each group] were recruited in this study by consecutive non-probability sampling. In group-A Karydakis technique was used while in group-B Limberg flap procedure was done. Data were analyzed using SPSS version 16 and by applying' t' test

Results: Comparison of mean period of hospital stay shows mean hospital stay 2.93 +/- 0.66 days in group-A and 3.97 +/- 0.71 days in group-B [p=0.001]. Similarly mean work loss was 13.13 +/- 1.15 days in group-A and 15.53 +/- 1.22 days in group-B. Significant difference was noted between two groups [p=0.001]

Conclusion: Karydakis technique, in treatment of pilonidal sinus disease is better in terms of short duration of hospital stay and less work loss. Karydakis procedure should be the preferred method in treatment of sacrococcygeal pilonidal sinus

Prevalence and antibiotic trials against Salmonella enterica isolated from diarrheic lambs and kids

Salmonella enterica [S. enteric] is the major zoonotic threat for small ruminants and humans responsible for huge economic losses and high mortality in Pakistan. Lambs and kids of Lahore district were examined to determine the prevalence, hematology and chemotherapy of S. enterica. A total of 200 diarrheic samples [n=100 lambs; n=100 kids] were collected and examined; 59 [29.50%] were found positive for S. enterica. Lambs had lightly greater prevalence [31%] than kids [29%]. The frequency analysis [OR=1.16 [reciprocal =0.87]] showed non-significant difference in both the lambs and kids. The significant decrease [P5R0.001] in hemoglobin, pack cell volume and total erythrocyte count was observed in infected lambs and kids. Results of in-vitro antibiotic susceptibility test revealed that S. enteric isolated from both lambs and kids were susceptible to levofloxacin, ciprofloxacin, ofloxacin, gentamicin, azithromycin, tobramycin, amoxicillin, ampicillin and nalidixic acid. Where as the results of in vivo antibiotic trials showed that isolates from both lambs and the kids with diarrhea were susceptible to levofloxacin and ciprofloxacin

Pattern of rubber bullet injuries in the lower limbs: A report from Kashmir / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Rubber bullets are considered a non-lethal method of crowd control and are being used over the world. However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist. The objective of this report was to add our experience to the existing literature.</p><p><b>METHODS</b>From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics, SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets. We documented all injuries and also recorded the management issues and complications that we encountered.</p><p><b>RESULTS</b>All patients weremales with an age range of 11e32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces. Among them, 19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs. All patients were received within 6 h of being shot.</p><p><b>CONCLUSION</b>Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest. The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.</p>

Green approach towards the determination of hydroxyzine dihydrochloride in pure and pharmaceutical dosage forms

A simple eco-friendly method has been developed for detection of hydroxyzine dihydrochloride in pure and pharmaceutical dosage forms. Both conventional system and microwave assisted procedures are used for the development of color. The blue coloured complex is measured spectrophotometrically at 750nm. Peak shift in FT-IR spectra also indicated the formation of complex

The reaction obeys Beer's law over the concentration range of 50-250ng/ml of hydroxyzine dihydrochloride

The precision value [infra-day and inter-day RSD] for the drug is not greater than 0.79% and recoveries were found to be in range of 99.01-99.99%

The designed method is applicable for periodic determination of hydroxyzine dihydrochloride in pure and pharmaceutical dosage forms

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children.</p><p><b>METHODS</b>We prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23), followed by fall from height (n=20), road traffic accidents (n=5) and fall from standing height (n=2). In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn's criteria.</p><p><b>RESULTS</b>Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn's criteria, 90.4% patients showed satisfactory results.</p><p><b>CONCLUSION</b>Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.</p>

Early stage ingrown toe nail and role of conservative treatment- an experience at Sukkur

To find out the frequency, causes and role of conservative treatment in early stage ingrown toe nail. Descriptive, observational, case series study. This study was conducted at the Department of Surgery, Ghulam Muhammad Mahar Medical College [GMC] ,Teaching Hospital, Sukkur from March 2011 to February 2012. Detailed history and physical examination especially local examination of the affected toe was made in OPD, to stage the disease. Only patients with early stage [Stage-I] ingrown toe nail were included in this study. Patients in advanced stages [stages-II and III], with history of diabetes, trauma, vascular diseases and all recurrent cases, which were operated upon in past excluded from this study. The patients were treated conservatively by advising for good foot hygiene and cutting the nails properly. Selected patients required wicking technique. This procedure was taught to patients so that they could do it once or twice daily at their homes. Patients were kept on antibiotics where required and simple pain killers. The patients were advised to visit the OPD regularly at defined time. 86 patients participated in this study, 54 [62.7%] were males and 32 [37.2%] were females with male: female ratio of 1.68: 1. Age ranged from 17-66 years, majority of patients were in between 21 to 40 years of age [44.1%] with mean age of 36 years. In majority of patients the right big toe was affected [n=56, 65.1%], in 22 [25.5%] left big toe and in 08 patients [09.3%] there was bilateral involvement of both big toes. Lateral nail fold was affected more [n=38, 44.1%] than medial fold [n=12, 13.9%]. In 36 [41.8%] patients both nail folds were affected. Various causative factors were identified with most important was improper nail trimming [n= 17, 19.7%] followed by tight fitting shoes [n=14, 16.2%] and idiopathic [n=02, 2.3%]. Majority of the patients [n=52, 60.4%] were only required antibiotic, pain killer and advice on foot care while 34 [39.5%] patients were advised for wicking. In our study, the success rate of conservative treatment remained 92.85% [n=65] at one year follow up. Ingrown toe nail is quite common condition. In early stage, it can be safely treated by conservative methods, if applied properly, which avoid disfigurement and train the patients to care for their own toes

Etiological factors and treatment outcome of genital and perineal necrotizing fascitis [Fournier's gangrene]

To analyze clinical and laboratory parameters in patients with Fournier's gangrene [FG] and to assess factors that determine mortality. A retrospective review of 82 patients with FG from January 2007 to December 2011 was made. They were divided into two groups: those who survived [survivors] and those who did not [non survivors]. We analyzed clinical and laboratory data. The mortality rate remained 36.6% [30/82 patients]. Increased heart and respiratory rates, elevated serum creatinine, pre-existing kidney disease, and higher extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension < 90 mm Hg] were also predictive for higher mortality. The median FG severity index [FGSI] score was higher in non survivors [22 vs 12, p < 0.0001]. Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were positively associated with mortality. Early clinical identification and prompt aggressive treatment are essential for reducing mortality and morbidity in patients

Comparison of conventional gauze therapy with vacuum assisted closure wound therapy in acute traumatic wounds

To compare the Vacuum Assisted Closure [VAC] wound therapy with Conventional Gauze Therapy [CGT] in management of acute traumatic wounds on the basis of time taken to achieve a vital red wound ready for definitive surgical closure. Randomized control trial. Department of Surgery Combined Military Hospital Rawalpindi from Mar 2009 to Sep 2009. This study included 82 patients of acute traumatic wounds. Patients were randomly allotted to group A, in which wound was treated with new method of vacuum assisted closure [VAC] wound therapy and to group B, in which wound was managed by conventional gauze therapy [CGT]. Outcomes were measured by the presence of vital red wound ready to be closed by surgical intervention. Patients with concomitant systemic pathology were not included in study. Comparison between the two groups revealed mean time for wound healing 13 days in group A and 16.9 days in group B with significant difference [p value =0.029]. Vacuum assisted closure wound therapy is an effective method in reducing time of wound healing for definitive surgical closure

Intra-abdominal pathologies

To evaluate relative frequency, reasons, avoidable responsible factors and outcomes of relaparotomy. Observational case series study. Department of Surgery Unit III BVH Bahawalpur. From 01-9-2009 to 31-8-2010. All the patients who presented in surgical outdoor, indoor and casualty department with severe intra-abdominal pathologies after primary laparotomies referred from low level, secondary care and tertiary care hospital and underwent relaparotomy electively or on demand were included in the study. Retrospectively their demographic characteristics, initial diagnosis with surgical information of primary laparotomy, factors and outcomes after relaparotomies were analyzed statistically. A total 54 patients were included in the study with male to female ratio of 1:2. Mean age of the study group was 30.91 +/- 12.5 years. Relative frequency of relaparotomy was 5.6%. Common center of referral was low level hospital 66.7%. Most common indication of relaparotomy was peritonitis in 52%. Most common complication of relaparotomy was wound infection 74%. Avoidable factors responsible for relaparotomies were found to be surgery at low level hospitals [77.3%] and by nonqualified surgeons [72.1%]. The rate of relaparotomy is very high because of unsupervised primary surgery in institutions and surgery by unqualified operators in private sector. Many of these are avoidable. In addition to decreasing the complication rate, primary surgery performed at tertiary care hospitals would decrease need for patients to undergo re-exploration

When to operate and abdominal gunshot wounds

Violence has become part and parcel of the daily routine of living, the prospective study of 86 patients, sustaining abdominal gunshot wounds was designed to evaluate the pattern, presentation and treatment outcome. Descriptive study. This study was conducted at the department of Surgery, Ghulam Muhammad Mahar Medical College Sukkur from January 2011 to January 2012. patients presenting with abdominal firearm wounds at accident and emergency department were included in this study, clinically all were evaluated, resuscitated and their findings were recorded on proforma. Patients with signs of acute abdomen [peritonitis]/ shock underwent midline emergency laparotomy, others having minimal or equivocal abdominal signs were selected for observation [non-operative management] group. Total number of patients included was 86, all were males, they belonged to age varying from 15-70 years. 54 [62.8%] were below the 40 years of age, in 44 [51.1%] cases instrument of attack used by assailant was pistol/shotgun, 45[52.3%] cases were victims of armed robbery, in 75 [87.2%] entrance wounds were present in anterior abdominal wall where as in 11[12.1%] were present posterirly, 67 [77.9%] underwent emergency laparotomy and 19 [22%] were observed initially. Two patients belonging to observation group showed failure, needed delayed laparotomy and both had positive laparotomy. Gunshot wounds of abdomen can be safely managed non-operatively, in the absence of abdominal tenderness haemodynamic instability or inevaluable factors as head injury and heavy intoxication. Success of non operative management depends upon continuous monitoring and frequent clinical examination

Anti-mycobacterial activity of garlic [Allium Sativum] against multi-drug resistant and non-multi-drug resistant Mycobacterium tuberculosis

Emergence of multi-drug resistant [MDR] and extensively drug resistant [XDR] TB throughout the developing world is very disturbing in the present scenario of TB management. There is a fundamental need to explore alternative anti-TB agents. Hence natural plants should be investigated to understand their antimicrobial properties and safety. Garlic [Allium sativum] is one of natural plant which possesses variety of biological properties like anti-tumor, anti-hyperlipedemic and anti-microbial etc. The present study was evaluated for antibacterial activity of garlic against non-MDR and MDR isolates of M. tuberculosis. A total of 20 clinical isolates of MTB including 15 MDR and 5 non-MDR were investigated. Ethanolic extract of garlic was prepared by maceration method. Minimum inhibitory concentration [MIC] was performed by using 7H9 middle brook broth dilution technique. MIC of garlic extract was ranged from 1 to 3 mg/ml; showing inhibitory effects of garlic against both non-MDR and MDR M. tuberculosis isolates. Alternate medicine practices with plant extracts including garlic should be considered to decrease the burden of drug resistance and cost in the management of diseases. The use of garlic against MDR-TB may be of great importance regarding public health

Analysis of causes and treatment modality in non-union of long bones diaphyseal fractures

The purpose of this study was to analyze the causes of nonunion leading to modification in treatment modalities in long bones diaphyseal fractures. Descriptive Study. Combined Military Hospital Quetta, Combined Military Hospital Sialkot, Pakistan, from 5th Sep 2005 to 26th Dec 2008. Non-healing long bones diaphyseal fractures > 6 months were included with exclusion of pathological fractures, delayed union < 6 months. Patients general profile and fracture details with non-union causes were recorded. Old failed surgery with re-do surgical intervention was analyzed. Infected cases were treated with removal of implant, thorough debridment, appropriate antibiotics followed by delayed stabilization while non-infected cases with stable fixation and bone grafting. Out of fifty six patients, tibial fractures were maximum 17[30.4%], femur 16[28.6%], radius ulna 15[26.6%], and humerus 8[14.3%]. Most patients were young 37[66.07%] and male 48[85.7%]. Road traffic accident caused 43[76.8%] fractures. Causes of non-union were high energy trauma 37[66%], insufficient stabilization 31[55.4%], followed by smoking, soft tissue interposition, poor nutrition, NSAIDs, broken implants, infection, intact fellow bone, multiple segment fracture, repeated manipulation, chronic illness and neurovascular impairment in descending order. Plates failed more than K nails. Complications like superficial and deep infection, neuroprexia and delayed healing settled with bone healing in mean time 4.76 months. Nonunion of long bones diaphyseal fractures can be prevented by avoiding causative agents, early intervention, tissue protection and stable fixation. Interlock nailing is best for femur, good for tibia, may be useful in humerus but not suitable for radius and ulna. Bone graft accelerates healing process. Early re do surgery must be considered because of manageable rate of complications

Laparoscopic cholecystectomy: an experience of 550 cases at Sukkur

To see the results and complication rate of Laparoscopic cholecystectomy at Sukkur. Prospective Study. This study was conducted at Ghulam Mohammad Mahar medical College Hospital Sukkur and Sukkur Blood Bank Hospital from December 2004 to December 2009. The study comprises of 550 case. All were admitted from OPD of both hospitals. All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy whether successful or converted were included in study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma and results were drawn. The male patients were 100 and female patients were 450, male to female ratio was 1:4.5. Mean age of patients were 47.63 years ranging from 25 years to 75 years there were 127 [23.09%] obese, 72 [13.90] controlled hypertensive. Anatomical obstacle noted in 40 [7.27%] patients. Adhesions in 52 [9.45%] and acute cholecystitis in 22 [3.75%] patients. Overall conversion rate was 4%. In total of 22 patients which were converted, causes were slipped clip, 2 hemorrhage from falciform ligament 1, severe hemorrhage 3, unclear anatomy 6, common bile duct injury 4, intra abdominal adhesions 4, gangrene gall bladder 1, and advance carcinoma 1. mean hospital stay was 1.8, ranges from 1 day to 10 days. Laparoscopic cholecystectomy has a gold standard procedure. It is safe and effective and becoming cost effective day by day. Incidence of complication is low, morbidity and mortality are low. The pain free postoperative period and early ambulation lead to saving of value able working hours

How early is early laparoscopic cholecystectomy in acute cholecystitis?

The efficacy and timing of early laparoscopic cholecystectomy for acute cholecystitis has been a subject of debate for years. Prospective comparative study, done at Ghulam Muhammad Mahar Medical College and Hira Medical Center, Sukkur, from July 2007 to June 2010. All patients undergoing Laparoscopic cholecystectomy for acute cholecystitis were included in the study. They were admitted through emergency with acute cholecystitis. Patients were divided into two groups according to the timing of surgery from the onset of symptoms. Group I included 205 patients who presented with acute cholecystitis within 48-72 hours of onset of symptoms and their surgery was done within 48-72 hours of presentation. Group II included 95 patients who presented after 72 hours of onset of symptoms and their surgery was done after 72 hours to one week of presentation. Clinical data was recorded and routine investigations along with ultrasound abdomen were carried out. The procedure performed, and its complications and success rate noted and compared between the two groups. The study included 300 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy within 48 to 72 hours of onset of symptoms in Group I and after 72 hours to 1 week in Group II. Among 300 patients there were 90[30%] males and 210[70%] females. The age of patients ranged from 20 to 70 years with a mean of 45 years. There were no open conversion in group I while 4.2% had to be opened in group II, the median operative time was 65 minutes in group I and 90 minutes in group II, postoperative hospitalization was 1 day in group I and 3.5 days in group II and total hospital stay was 2 days in group I and 4.5 days in group II. Intra-operative and postoperative complications were less in group I as compared to group II. Early laparoscopic cholecystectomy within 48-72 hours of onset of symptoms results in lower conversion rate, shorter operative time and reduced hospitalization. All patients with acute cholecystitis should be operated within 48-72 hours of the symptoms

Epidemiology and management of intra-abdominal injuries due to criminal abortion

To collect data about different aspects of epidemiology of intra-abdominal injuries due to criminal abortions and devise a plan of management for various categories of intra-abdominal injuries. This observational case series study was carried out in Surgical unit 2, Bahawal Victoria hospital, Bahawalpur, from January 2006 to December 2007. A total of 40 consecutive patients were studied. All patients of abdominal injuries due to criminal abortion were included in the study. Patients of criminal abortion having only gynaecological complications i.e. per vaginal bleeding, septicaemia and acute renal failure were excluded from the study and only the patients with abdominal injuries were included. Relevant history and appropriate physical examination was performed and necessary investigations were done. Exploratory laparotomy was performed and injuries were treated accordingly. The most common age group developing intra-abdominal injury due to criminal abortion was of 25-34 years [77.5%]. Most of these abortions were in first trimester [70%], in women belonging to poor socio-economic status [80%]. Sixty five percent of these abortions were induced by semi-skilled persons, mostly by dilatation and curettage [70%]. The most common clinical presentation was painful abdominal distention [57.5%]. On laparotomy, gut injury was found in 20 [50%] cases, out of which 12 [60%] cases underwent gut exteriorisation. Isolated uterine injury was observed in 13 [32%] cases, out of which 12 [92%] patients underwent primary uterine repair. Intra-abdominal injuries due to criminal abortions are a definite entity. They usually present as acute abdomen. Exploratory laparotorny is mandatory; viscera most commonly injured are gut and uterus

Percentage of CD4[+] and CD8[+] T-lymphocytes in blood of tuberculosis patients

Tuberculosis is a fatal infectious disease, mainly caused by Mycobacterium tuberculosis. Spread of TB is controlled by cell-mediated immunity. Purpose of this study was to determine CD4[+] and CD8[+] T cell percentages in TB patients. 77 subjects consisted of 39 patients of active tuberculosis and 37 normal healthy individuals were recruited for the study. Among patients, 27 were at different stages of anti-tuberculous therapy while rests of the patients were not taking treatment. Sixteen patients were sputum positive for AFB while other patients were sputum negative for AFB. T cells percentages were determined by flow cytometer. In TB patients CD4[+] and CD8[+] T cells percentages were 34.4 +/- 9.8 and 32.0 +/- 9.8 while in controls these were 37.1 +/- 6.9 and 30.2 +/- 7.2 respectively but the difference was statistically insignificant. CD4[+] T cell percentage in newly diagnosed TB patients was 28.8 +/- 8.7 while it was 37.9 +/- 8.9 in TB patients who were on therapy and difference was statistically significant whereas difference in CD8[+] T-cell percentages was statistically insignificant. A negative correlation between CD8[+] Tcells percentage and the duration of ATT was found. CD4[+] and CD8[+] T-cells percentages may help to find out the immune status of TB patients before and after the completion of ATT

Gynaecomastia; management and causative factors

To determine the causative factors and management of Gynaecomastia. Observational case series study. Surgical Unit-1 Bahawal Victoria Hospital Bahawalpur, from 1st January 200 till 31st December 2007. Thirty male patients having breast swelling were included in this study. Relevant history was obtained. Appropriate | physical examination was performed. Necessary investigations were done and after making a diagnosis appropriate treatment was done. A total of 30 patients were studied in the study period of 18 months. Those male patients who were having breast lesion other than benign enlargement [e.g. Ca. Breast, Breast/Abscess] were not included in the study. Necessary investigations were done. Subcutaneous I Mastectomy was performed. The most common age group developing gynaecomastia was of 20-30 years [60%]. Bilateral gynaecomastia was observed in 76.66% and unilateral gynaecomastia in 23.33%. Idiopathic gynaecomastia was observed in 73.33% cases. Medical treatment was given with tamoxifen 10mg twice a day for the period of three months in 6 case [20%] and this remained effective in 5 case [83.33%]. Subcutaneous mastectomy was performed in 17 cases [56.66%]. Post-operative complications were seen in 4 cases [23.52%], the most common complication being wound hematoma in 2 cases [11.76%]. Most of the patients [88.9%] were fully satisfied with the results of subcutaneous mastectomy. Gynaecomastia is the most common benign lesion of the male breast. As far as physiological gynaecomastia is concerned, patients should be observed for at least 2 years from the onset of their condition. In most of the cases spontaneous resolution occurs. Surgical treatment should be planned in whom spontaneous resolution does not occur. Surgery remains the mainstay of therapy and is frequently indicated for psychological and cosmetic reasons

Level of interferon gamma in the blood of tuberculosis patients

Interferon gamma [IFN- gamma], a cytokine produced by a variety of cells is involved in the immune response against M. tuberculosis. It activates the production of other cytokines and molecules that kill mycobacterium. IFN- gamma also has diagnostic role in identification of active and latent tuberculosis. To determine the level of IFN- gamma in the blood of TB patients. Ninety-one subjects were selected, including 54 active TB patients and 37 healthy controls. Among 54 TB patients, 27 had confirmed TB and 27 were clinically diagnosed as having TB. IFN- gamma concentration was determined in their blood by an ELISA technique. In TB patients, Mean +/- SD of IFN- gamma was 48.69 +/- 28.78 pg/ml while it was 12.99 +/- 5.70pg/ml in the control group [p <0.001]. Significant differences in the level of IFN- gamma were observed among confirmed TB patients, clinically diagnosed TB patients and the control group [Mean +/- SD 59.68 +/- 28.78, 36.85 +/- 24.76 and 12.99 +/- 5.70 pg/ml, respectively]. Furthermore, a significant negative correlation was observed between the concentration of IFN- gamma in TB patients and the duration of anti-tuberculosis therapy. IFN- gamma level was high in both clinically diagnosed and confirmed TB patients as compared to a control group. Measurement of IFN- gamma production is helpful to diagnose active tuberculosis, but further research is required